Korean J Anesthesiol. 2025 Apr 25. doi: 10.4097/kja.24934. Online ahead of print.
ABSTRACT
BACKGROUND: Predicting fatal neurological complications after clipping surgery for unruptured intracranial aneurysms (UIAs) is crucial; however, existing scoring systems are limited by narrow consideration of factors. We aimed to develop and validate a comprehensive risk stratification scoring system that incorporates patient-, aneurysm-, and operation-specific variables for predicting postoperative neurological complications in UIA surgeries.
METHODS: This multi-center retrospective cohort study was conducted from September 2018 to October 2023. Patients undergoing clipping surgery for UIAs were divided into development and validation sets based on the treating institution. A predictive score for postoperative neurological complications was developed from a multivariate logistic regression analysis. The score, named NEURO, that incorporates variables like previous neurological disease, categorized aneurysm location and size, categorized operation time, and transfusion was validated externally.
RESULTS: The study included 2847 patients, with 1547 and 1300 in the development and validation sets, based on the institution of surgery, respectively. The incidence of neurological complications was 5.7% (88 / 1547) and 5.6% (73 / 1300) in the development and validation sets, respectively. The NEURO score showed good predictive ability with C-statistics of 0.720 (95% CI, 0.667-0.776) in the development set and 0.693 (95% CI, 0.631-0.754) in the validation set, demonstrating good calibration across the predicted probability range.
CONCLUSIONS: The NEURO score, integrating multiple perioperative variables, may effectively predict the risk of neurological complications post UIA clipping surgery, aiding in identifying high-risk patients. This tool could enhance clinical decision-making and patient management in neurosurgical practice.
PMID:40276889 | DOI:10.4097/kja.24934
